Comparison of three different operative methods of video-assisted thoracoscopic esophagectomy

Background. Although the feasibility and advantages of video-assisted thoracoscopic esophagectomy (VATS-E) for esophageal cancer are well studied, its application is limited, possibly because it is technically complex. Methods. Ninety-eight patients who underwent VATS-E at our institutes were divided into three groups by the type of thoracoscope, TV monitor, and patient position used. For the first 18 patients, we used the left lateral position, a flexible thoracoscope, and a single TV monitor (method A); for the next 58 patients, the left lateral position, a 30 degrees thoracoscope, and two TV monitors (method B); and for the last 22 patients, the prone position with 30 degrees thoracoscope and single TV monitor (method C). We compared the area of operative field and clinical outcomes in these three approaches. Results. On the basis of subjective assessment, method C afforded a better operative field than methods A and B. No significant differences were noted between the three positions in operative time, duration of intubation, rate of occurrence of recurrent nerve palsy, and anastomotic leakage. However, blood loss, rate of respiratory tract complications, and length of postoperative hospital stay were decreased in the order of position. The total number of dissected lymph nodes increased in the order of position. Conclusions. VATS-E in prone position with a 30 degrees thoracoscope and a single TV monitor appear to be superior to VATS-E in the left lateral position in terms of operative field, blood loss, respiratory tract complication, and number of lymph nodes dissected. Randomized control studies would help confirm these results.